Mobility Device Use and Hearing Impairments Among Individuals and Households, 1990-2010

In response to a request by the US Access Board for population based data in conjunction with proposed scoping requirements for guest rooms with mobility features and guest rooms with communication features on cruise ships, this report provides updated population based statistics on trends in the percentage of individuals and households with members who use wheelchairs or other mobility devices and the percentage of individuals and households with members who have hearing impairments.

Data and Methods

We use all available data from the Survey of Income and Program Participation (SIPP) over the period 1990 to 2010. The SIPP provides stability in measuring disability over a long time period with a large sample that is representative of US households and individuals. The SIPP is the best source of information on use of wheelchairs and other mobility devices over time and also provides useful information on hearing impairments. The statistics are for the civilian household (non-institutional) population ages 6 and older or ages 18 and older as noted.

Household members often travel together on recreational trips, especially cruises. A guest room with mobility features or communication features is needed when any travelling household member requires these features. Therefore, in considering proposed scoping requirements for guest rooms with mobility features or communication features, statistics on households are more applicable than statistics on individuals. However, national statistics on disability are rarely published for households; this report presents the authors’ analysis of the SIPP for households as well as individuals. The data and methods employed in analyzing the SIPP for adults are described elsewhere (1). In the analysis of households, the same methods were used, with the additional step that information from all household members was aggregated to the household level, e.g., households in which any member used a wheelchair. For estimation of household statistics, the survey weight for the head of the household was used. For mobility device trends, household statistics include only members ages 18 and above because the SIPP did not ask about mobility device use among children ages 6-17 in 1990-1995. Hearing questions were changed in the SIPP in 1997 and are not comparable to earlier years; thus the time period covered is 1997 to 2010. Household statistics for hearing impairment include members ages 6 and older.

Mobility Device Use

The SIPP has asked about use of mobility devices, including wheelchairs, scooters, canes, crutches, and walkers, among all adults since 1990 and for all persons ages 6 and over since 1997.[1]

From 1990 to 2010, the household rate of wheelchair use doubled from 1.5 to 3 percent (Figure 1). This reflects the growth in use of wheelchairs that we have observed previously for individuals (2). If past trends continue, a linear extrapolation to 2025 suggests a rate of just above 4 percent of households with wheelchair using members. The rate of wheelchair use for adults has also doubled from 0.8 percent in 1990 to 1.6 percent in 2010 (Table 1).

Ten percent of households had a member who used any mobility device — including wheelchairs, scooters, canes, crutches, and walkers — in 2010 (Figure 2). The household rate of using mobility devices has grown by about 67 percent from 1990 to 2010 with a trend that is close to linear. If past trends continue, a linear extrapolation to 2025 suggests a rate of about 13 percent of households with members using mobility devices.

These statistics are based on just the adult members of the household. Starting in 1997, children ages 6 and older have also been asked about mobility device use. However, the number of children using mobility devices is small compared to adults. Including these children increases the household rate by only 2-5 percent, depending on the year (Table 1) and has no effect on the trend or its extrapolation.

Note: Author’s analysis of the Survey of Income and Program Participation. Includes adult household members ages 18 and older.

Hearing Impairments

Several national surveys attempt to measure hearing loss, but measurement is not standardized, with large variability in question wording and consequently estimates. Audiometric testing is considered the best way to assess hearing loss. The National Health and Nutrition Examination Survey (NHANES) is the only survey to include audiometric testing for hearing loss of 25 dB of the pure-tone average of hearing thresholds at speech frequencies. Audiometric results from NHANES show that about 9 percent of men and about 4 percent of women 20-69 years old have hearing loss (3). A comparison of survey reports from NHANES, the National Health Interview Survey (NHIS), the Medical Expenditure Panel Survey (MEPS), and the SIPP against audiometric test results found, for adults ages 20-69, that both the MEPS and the SIPP underreported hearing impairment and that the NHANES and the NHIS produced substantial overreporting, with up to 25 percent of men reporting some trouble hearing in NHANES (3). Survey questions in NHANES and the NHIS are based on a four point rating scale of hearing trouble (no trouble, a little, a lot, deaf). In contrast, the SIPP questions ask whether a person uses a hearing aid, and whether a person has difficulty hearing what is said in a normal conversation (even when wearing a hearing aid) or is deaf. This appears to be a more objective approach than using a rating scale of hearing difficulty although it results in some underreporting compared to audiometric testing. In this report, we present results from the SIPP based on a positive response to either question for the prevalence of any hearing impairment.[2] For the prevalence of severe hearing impairment, we present results based on a positive response if the person uses a hearing aid or the person is deaf.

About 4-5 percent of households have a member who uses a hearing aid or is deaf. Unlike for mobility devices, no consistent trend over time is apparent (Figure 2). The rate among individuals aged 6 and older is approximately 2 percent (Table 2). From 8-10 percent of households have a member with any hearing impairment (Figure 1). Among individuals aged 6 and older, the rate was about 4 percent. While some analysts have suggested an increase in hearing difficulty due to the aging of the population, two studies have noted a decline in hearing difficulty since 1990 that has appeared to level off after 2000 (1, 3). In the absence of any clear trends, the best estimate for the prevalence of hearing impairments in households by 2025 is the current rate of 8-9 percent.

Note: Author’s analysis of the Survey of Income and Program Participation. Includes adult household members ages 6 and older.

References:

1. Kaye HS. Disability rates for working-age adults and for the elderly have stabilized, but trends for each mean different results for costs. Health Aff (Millwood). 2012 Jan;32(1):127-34.